


I'm Holding On To What I Know

by marsakat



Series: Broken People, we're here to fix you (hospital AU) [1]
Category: Twenty One Pilots
Genre: Alternate Universe - Hospital, Alternate Universe - Medical, Fluffy Ending, Implied/Referenced Suicide, M/M, Tyler is an ER doctor that never wants to give up on his patients
Language: English
Status: Completed
Published: 2016-03-15
Updated: 2016-03-15
Packaged: 2018-05-26 19:13:56
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 2,075
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/6252112
Author URL: https://archiveofourown.org/users/marsakat/pseuds/marsakat
Summary: <blockquote class="userstuff">
              <p>He was clinically dead for twenty minutes, and if the ER doctor had stopped resuscitating after fifteen, Tyler would never have saved the lives he has saved.</p>
            </blockquote>





	I'm Holding On To What I Know

**Author's Note:**

> To make a long story short, I was watching "Untold Stories From The ER" and was inspired by a really hilarious scene. Of course I 'imagined my OTP' and boom this fic was born in 2 hours. More notes and med jargon translation at the end

It’s often said that the sickest patients are the ones that come off the street, with the vague complaint of “just not feeling right”.  That’s why emergency medicine is so exciting, you never know who or what will be sitting in that bed.

It was a Wednesday at 11am, and the day had so far been thankfully—no don’t use the word “quiet”—steady but calm.  No major car accidents or gunshot victims arriving at the trauma center yet, and all the cases Dr. Tyler Joseph had seen were so far easily diagnosable and treatable—minor burns from hot oatmeal, head laceration, uncomplicated pneumonia, and an appendicitis that was already sent off to the operating room.  Everyone was busy, but that just made the hours pass by quicker.  As the senior, fourth-year ER resident, he felt at home in the hustle and bustle, cracking jokes with the nurses and the other doctors in between dictating his reports, and helping out the newer residents.

Tyler was sipping his daily midmorning Red Bull—a necessity for these long shifts, though the nurse manager may wring his neck for breaking the hygiene policies—his fingers itching for something exciting to do, when the charge nurse walking by said “Hey doc, we’ve got a probable MI in bed 12, and it looks like the other residents are all busy, would you take this one?” 

“For you—anything,” He batted his eyelashes at the fifty-something, tough ER nurse, who let out a barking laugh and tossed a pen at Tyler’s head. 

He pulled up the triage nurse’s report on the computer: “63 y/o male, CC: CP & mild SOB x3h. NKDA. PMH: HTN, former smoker, hypercholesteremia, BP 101/52 HR: 65 RR: 24 Temp: 98.4 Sat 94% 2L NC”. Figuring better get started sooner rather than later, Tyler pushed back from the desk and strode over to the room.  The nurse was already at work starting an IV line and drawing blood for tests, and the ER tech was setting up an EKG—the machine was smoothly run here; everyone knew what to do and anticipate the orders. 

“Hello Mr…Stanton,” Tyler said, glancing at the chart, “I am Dr. Joseph, and I will be taking care of you.  So what brings you here today?”  Tyler could already see the patient was not looking very great—sweaty and pale, breaths were obviously labored. 

“I dunno—I was taking in my trash cans and…it felt like an elephant was sitting on my chest,” said Mr. Stanton. 

“Could you hold still for a moment, sir?” asked the tech, “We just need to run this EKG.”  A few beats past, and the tech nodded to Tyler who swooped in with his stethoscope and started listening to the patient’s lungs and heart.

 “Has this happened before?” Tyler asked, hearing no crackles in the lungs, but noticing distended neck veins. His abdomen was soft, and non-tender.

 “No, this was the first time.  My wife gave me some aspirin, and brought me right here. The pain hasn’t gotten any better though.”

 “Your wife is very smart, sir,” said Tyler, taking the EKG report, and immediately noticing ST elevation in leads II, III, and AVF. That’s very not good, but Tyler was well practiced at appearing calm in the face of danger. “Well Mr. Stanton, it seems that you may be having a myocardial infarction—a heart attack, which is when a blockage stops the blood flow to part of your heart muscle.  This is very serious, so we are going to take an x-ray of your chest, look at your lab results, and probably send you to the cath lab. They will put a stent there to open up the artery.  We will be moving very quickly, is your wife here?”

 “Yes…she’s…at the front desk—” and then the patient turned grey and his eyes rolled back into his head, and both Tyler and the patient’s hearts stopped—figuratively and literally.  Instinctively Tyler felt for a carotid pulse, and found nothing as the nurse was slamming her hand on the code blue button above the bed, and yelling for the crash cart. Meanwhile, Tyler was setting the bed into CPR mode, and beginning chest compressions—so much for a quiet day in the ER.

* * *

 

 It was just him and the patient for two whole minutes, as people rushed into the room and worked around him.  They were seamless, and Tyler only had to bark out a few orders as he kept the steady compressions.  He always followed the beat of _Stayin’ Alive_ while watching the monitors that were being set up. Tyler even said a little prayer that this man will pull through.  A med student tapped him on the shoulder after those first two minutes, and they did a pulse and rhythm check.  Tyler was beginning to sweat a little—giving good compressions can be hard work! 

 “Looks like v-fib, let’s get ready to shock and 1 milligram of epi,” he said, slipping into the role of team leader since he was the most senior doctor there.

* * *

 

 Fifteen minutes later, twenty, thirty, and they were still working on the patient, with him flipping in and out of v-fib, then v-tach with a pulse, and then PEA.  Tyler could feel the team become restless and eying him to see if he would call the code, but today Tyler was not ready to give up on Mr. Stanton whose wife was now standing off to the side of the room, tearful and watching everything as a nurse explained what was happening.

 Tyler bent down and spoke right into the patient’s ear “Come on Mr. Stanton! Your wife is here and you need to work with us, okay?” He knew the other doctors were probably rolling their eyes at him, because he often had a habit of talking to unconscious and fairly dead patients.  Tyler could care less what they thought, because they had no idea what he was thinking.  Every patient like this reminded him of his father, grandfather, or someone else he loved.  No matter how many dead or dying people he saw, he refused to be jaded by the statistics, because he was here thanks to a doctor that refused to give up on him.

 Tyler always wore a long sleeved shirt under his scrubs and white coat and most people initially thought it was because of the tattoos that banded across his left arm.  The first time he went out to a bar with some of his coworkers, and he rolled up his sleeves because of the heat.  An eagle-eyed plastic surgery fellow noticed the scar that ran from radiocarpal joint to the cubital fossa. Tyler knew that everyone was whispering about it within a few days—gossip travels quickly throughout a hospital, and especially in one’s own department.  He knew exactly what they thought, since it became obvious that Tyler would always assign himself to the attempted suicides, working with a steely glint in his eyes as he stitched up wrists, and pumped stomachs full of pills and alcohol. 

He was clinically dead for twenty minutes, and if the ER doctor had stopped resuscitating after fifteen, Tyler would never have saved the lives he has saved.  Sometimes he got carried away with himself, and that’s why he found himself at minute forty-five practically shouting at Mr. Stanton to “stay alive! Stay alive!”

He needed a pulse in order to be able to go up to the cath lab—no matter how many times Tyler begged the cardiologists, they refused to see patients unless their hearts were beating. 

But there it was…a weak pulse, but undeniably there.  Tyler was ecstatic, trying to control his excitement.  ROSC always made him want to dance, but with a family member in the room, he knew the chief attending would have to give him another talk about acting appropriate.

“Call cardiology—we’re going up there stat,” Tyler said, and the team threw everything onto the stretcher—monitor, oxygen tank, etc—and they began to run towards the doors as Tyler continued to talk to Mr. Stanton, who was still unconscious.

“You’re doing great, just hold on till we get upstairs, come on, come on!”

The cath lab was up one more floor, and the heart monitor beeped a slow beat. Tyler took a moment to look at everyone else while waiting for the elevator. Two nurses, a tech, a second year resident, and a med student—everyone looked wrung out and exhausted, but the exhilaration of _saving a life_ lit up their faces.  This is what Tyler lived for, but they were not yet out of the woods. 

It was only in the elevator and the doors beeped as they arrived on the next floor, that the monitor alarmed loudly and the other resident cursed loudly. 

 “No pulse!” called a nurse, and Tyler did what everyone knew not to do.  Pretty much lesson one of doing CPR is that you never ever, ever climb onto the stretcher because you need to be able to move away for defibrillation.

 Call it momentary insanity, but in one swift movement, Tyler found himself on top of the patient, back to doing compressions. 

“Dr. Joseph!” shouted a nurse, “What the hell are you—”

 “Go! Go! Just go!” Tyler shouted back, and soon found himself being propelled down the hall at breakneck speed.  He was vaguely aware of the open mouth, gaping stares from everyone they past, and at any other time it would be hilarious, but Tyler was too busy shouting, praying, and singing _Stayin’ Alive_ to care.

 It was a magnificent jolt when they crashed through the double doors to the cath lab suite, and the normally calm domain of the cardiologists broke out into pandemonium as Tyler started shouting orders from on top of the stretcher.

 “Tyler! Not again!” shouted the cardiology fellow, who looked absolutely dumbfounded, “I told you they need to have a pulse!”

 “I know, okay?!” Tyler yelled, and he was absolutely drenched in sweat, “We got a pulse back for like 5 minutes, and it only _just_ went away. Please give us a chance!”

 “Tyler—you know I can’t—”

 “Josh please!”

 “But—”

 “I’ll make it worth your while” Tyler smirked and winked at his boyfriend.

 “Can you two cool it with the flirting? It’s time to check the pulse” one of the nurses said, rolling her eyes.

 Josh’s expert fingers found the carotid artery, and his own eyes widened in shock as he looked up into Tyler’s shining face.  “Get off the bed and get out of my department before you break something,” Josh said, signaling to his assistant to start prepping the patient.  Tyler climbed down and, after aiming a gentle smack to Dr. Dun’s ass, he practically skipped out the door.

* * *

It wasn’t until they were back in the elevator that the team broke down into crazed laughter.

 “The look on his face when we came through those doors and you were on top of the patient!” wheezed the resident.

 “Tyler! Not again!” mimicked the nurse.

 Tyler grinned, ignoring the statistics.  Forty percent survival after resuscitation and only ten to twenty percent survive to be discharged.  He put the victory into his coat pocket, and returned to work—after showering in the locker room and grabbing another Red Bull.

* * *

 

At 6pm, his phone buzzed in his pocket just as he was signing out for the day, chancing a glance down to see “where r u? I’m at the nurses’ station”.

 “give me a sec” Tyler texted back, and five minutes later he was striding around the corner to find the red haired cardiologist leaning holding two coffees and leaning against the desk, talking with the charge nurse.  Tyler’s heart pounded as he slipped an arm around Josh’s shoulders. They bid the others good night, and walked to the exit.  Tyler took a sip of the coffee, afraid to ask what had been lurking in the back of his mind for the rest of the day.

 “How’d it go with the patient I sent you?” he asked tentatively as they walked to the car.

 “90% blocked, but we managed to get a stent in and send him up to the unit,” Josh grinned, “Serious but stable.  You did good.”

 “I always do” Tyler puffed out his chest as Josh patted directly over his heart.

 “But seriously, you need to stop climbing.”

**Author's Note:**

> Wow! My first fic in many, many years and first to post to AO3! I hope you enjoyed, and this may be the first of other hospital AUs. You may or may not be able to tell, but I'm actually a real life, honest-to-god nurse, so I tried to be as accurate as possible, even though this isn't my specialty. Please let me know what you thought, and if you need help with medical accuracies in your own fics, please let me know! I'm happy to share my expertise.
> 
> I'm shivermepickles on tumblr. Come talk to me!
> 
> Translation to the triage nurses' report fyi: sixty-three year-old male, chief complaint of chest pain, and mild shortness of breath for three hours. No known drug allergies. Past medical history of high blood pressure, former smoker, and high cholesterol. Blood pressure 101/52, pulse of 65, temperature is 98.4 degrees Fahrenheit, oxygen saturation 97% on two liters of nasal cannula  
> MI: myocardial infarction  
> ROSC: return of spontaneous circulation (a successful resuscitation) 
> 
> Also I hope you caught that I made Josh a cardiologist because it's all about keeping a beat.


End file.
